From the category archives:

Second Opinions

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The sign “Magnolia Cancer Center” does not look as surreal as it has during my previous visits. After all, I do have breast cancer and this center is for me. Although I do not yet have the hollow eyes, the waxy complexion, the bloated body, or the shuffling gate of so many of the other cancer patients I see here. I suppose it is because I have yet to start my treatments.

A large black woman with a gap between her teeth greets me. Her look is that of kindness and concern, but not pity. I must have “new patient” written all over me. Eventually, I ,too, will be ground down by all the chemicals and look like the others: a shadow of former self.

The oncology department’s reception is as spacious as a hotel lobby, and lit by large windows. Someone has obviously dumped a serious amount of capital into this interior. (Although not enough money to allow the purchase of scanners to allow the doctors to email reports to patients.) Yet, the setting is remarkably different from Dr. Weary’s crowded, and a bit shabby, office.

The first person to check me is not Professor Oncology. It is a short, slightly round faced man in a white coat. I assume he is a student at first. Then I notice his  name tag.  He is already a doctor,  a  fellow in oncology, he explains. He seems kind, serious, and gentle. He weighs me in fully dressed and I wish I had kicked off my shoes to reduce my chart by a pound.

Professor Oncology looks Indian and seems too young to be a full Professor and Cancer specialist . Had I met her in a hospital corridor I would have taken her, too,  for a  medical student. Her black straight hair hangs down below her shoulders as does her drab navy skirt which goes inches below her knees and her white coat.  Her face is completely devoid of makeup. Her hands have a pianist’s sinewy, long fingers. Carefully, she feels about my neck, looking for signs of swollen nodes. She feels my breasts, and my armpits. She asks for permission for Dr. Fellow to examine me also.

Dr. Fellow stops with both hands around my neck and looks over at the Professor. He must think that he found something. I tense up, but she shakes her head. I immediately relax as does he.

The professor does not print out an adjuvant online graph like both Dr. Guru and Dr. Weary did. Instead, she  scribbles a few things on the back of a piece of paper. She tells me what I already know: stage 1, node negative, ER/PR + strongly so, HER/2 neg. grade 1 tumor. Like Dr. Weary, she is a bit baffled by my relatively high oncodx score.  It is 23. But she is still convinced that chemo would only improve my odds by 2%.  The professor, more than any of the others, stress the toxicity of chemo therapy: Leukemia, heart problems, bone marrow loss, risk for other infections.

Unlike, Dr. Weary, she does not agonize even a bit about skipping chemo. To my immense relief, she seems to have no doubts. She does not wring her hands, does not stand up only to abruptly sit down.

She draws up a five-year plan for hormone therapy: five years on Tamoxifen.  Or, she suggest,  we can do 21/2 years  and then switch to Arimidex, an aromatase inhibitor. I look aghast. “Oh well, Tamoxifen then,”  she shrugs. She does not ask what I have against Arimidex. She gives me an appointment for two months later when radiation will, supposedly, be over. She does not explain why I can not be on hormone blockers while on radiation. She does not bring up insufficient margins. I do not tell her about Dr. Alpha other than to mention that I will have radiation at a hospital closer to home.

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Dr. Alpha, my new radiation oncologist, flips back and forth  in my pathology report. He seems annoyed. Not with me, but with the report. He pushes the reading glasses back on top of his head. “I don’t understand this,” he says. His tone bristles, but he looks kindly at me as he stabs his finger at at the bone of contention, my pathology report and the words “all other margins free of carcinoma.”

I am a bit embarrassed because in the margin I have scribbled: WTF.

“Oh no!” I hurry to explain everything, not  to defend Dr. Guru but  to sooth Dr. Alpha. I don’t want him to get more agitated and annoyed with Dr. Guru. I fish the Vanderbilt report out of my purse and show him  exhibit number one: Vanderbilt confirmed the first pathology report from my lumpectomy.

“Dr. Guru explained everything in his emails.” I tell Dr. Alpha. “I can send you copies. ”

Dr. Alpha does not seem convinced.

“Well, something is wrong.”

He starts to explain why my pathology report  is wrong, then abruptly stops himself.  He realizes that I can not process the meaning of his words so he draws a picture. “Here is the lateral margin,” he begins and goes on to explained how there has to be one. Then he goes back to the report, flips back and forth before he, frustrated, tosses the pages back on the table. Obviously, the answer he wants is not there.

“Either your pathology report is wrong or your surgeon is wrong,” he says firmly. Although he seems irritated with the report, a bit angry even, Dr. Alpha manages not to be the least bit unpleasant. “This is not right and I can not treat you like this. I read these reports all day long.  All day long. That is what I do for a living and I have seen everything.”

I am tempted to ask him about “everything,” but I guess that it would take an eternity and be way over my head anyway. Darn I wish I had paid more attention to science and not blown it off as “nerdy.”

“Forget Vanderbilt! They just confirm tissue cells. They don’t confirm margins,” he says and hands back the Vanderbilt result.

“Either the pathologist marked the slides wrong or the surgeon is wrong and has to redo it and give you a re-excision.” says Dr. Alpha.

“But that will take for ever? He is busy.”

“Not at all. He owes you. He will just have to get up a bit earlier in the morning. I am here till seven or eight at night. My colleague, Dr. E’s car never leaves here before 7.30 PM either.”

I mildly defend Dr. Guru. “I am sure he works that late too. In fact, some of his emails are sent late at night.”

“I will put in a call to him right now.”

“Good luck!”

“Let’s start with your pathologist then. Do you have her number?”

I scroll through my Blackberry while Dr. Alpha in a typical Type A fashion watches over my shoulder. “No, not that number, that’s not it. Oh, so you don’t have it,” he says while I am still scrolling. “Well, I will take care of it and I will call you by Friday. This will be cleared up by then, one way or the other. Either you have to have another surgery next week or we can start your radiation.”

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